The topic of miscarriage is still sort of a taboo topic in our society. Our mothers, grandmothers, and their mothers before them didn’t talk about miscarriage at all. It was something that was considered ‘just one of those things that comes with being a woman’, and better left unsaid. Today it is becoming more socially acceptable to talk about and grieve openly. We are even beginning to hear and see stories about miscarriage and couples sharing their grief publicly in mainstream media. However, unless personally affected by miscarriage most people are still fairly unaware of how common miscarriage is, its effects on emotional and mental health, and what to say (or not say) to a friend or loved one experiencing miscarriage.
Miscarriage is defined as the spontaneous loss of a fetus before the 20th week of pregnancy (pregnancy losses after the 20th week are called stillbirths). Miscarriage is a naturally occurring event. Miscarriage is very common, occurring in every 1 in 4 pregnancies.
Most miscarriages are caused by chromosome problems that make it impossible for the baby to develop. In rare cases, these problems are related to the mother’s or father’s genes.
Other possible causes of miscarriage may include:
- Drug and alcohol abuse
- Exposure to environmental toxins
- Hormone problems
- Physical problems with the mother’s reproductive organs
- Problem with the body’s immune response
- Serious body-wide (systemic) diseases in the mother (such as uncontrolled diabetes)
Around half of all fertilized eggs die and are lost spontaneously, usually before the woman knows she is pregnant. Among women who know they are pregnant, few women will have a miscarriage. Most miscarriages occur during the first 7 weeks of pregnancy. The rate of miscarriage drops after the baby’s heartbeat is detected.
Symptoms include bleeding, cramping, or passing tissue or large clots from the vagina. Although once these symptoms begin to occur there is almost nothing that can be done to stop the miscarriage, a woman should contact her doctor immediately. Your doctor or midwife will typically provide an ultrasound to determine if a miscarriage has occurred or if the fetus is still viable (in other words, if the baby has a heartbeat). In some cases your doctor will order blood work to check your pregnancy hormone levels, called beta-HCG levels to help determine if the pregnancy has a chance at survival. Following these levels over many days may be useful in determining whether or not a miscarriage is occurring. It is not necessary to follow these levels in all cases.
A number of things can lead to isolated or recurrent miscarriage. The most common being a chromosomal abnormality where the genetic material from the sperm and egg do not fuse together appropriately. This is the reason for about half of all miscarriages and is usually a random occurrence. A variation of this type of miscarriage is called a “blighted ovum”, where the water bag and placenta develop but not the fetus. However, in about 9 out of 10 of cases the next pregnancy after these types of miscarriage is to term. This is why most doctors will not order a complex evaluation after a single, first-trimester miscarriage. Further investigation into reasons for miscarriage usually occur once a woman has had 2 or 3 recurrent miscarriages without a live birth in between. Doctors can find a cause of recurrent miscarriage in about half of all cases.
- Medical condition in the mother such as diabetes or thyroid disease
- Hormone imbalances
- Immune system responses
- Uterine abnormalities
An abnormality of the uterus (womb) is the reason for about 10-15% of recurrent miscarriages. When the uterine muscle is slightly malformed the pregnancy cannot grow appropriately and as a result recurrent miscarriage may occur. This problem is diagnosed with a special x-ray or ultrasound of the uterus and surgery to correct the defective area is usually successful in curing the problem.
There are different kinds of miscarriages that can occur at different stages of pregnancy. Symptoms will vary depending on the type of miscarriage.
- Threatened miscarriage
- Missed miscarriage
- Blighted ovum
- Ectopic pregnancy
- Molar pregnancy
- Chemical pregnancy
- Incompetent cervix
It is important that couples realize it is not their fault the miscarriage occurred. Miscarriage is a devastating situation, and something that will forever affect you and shape your outlook on child bearing. The physical recovery from miscarriage may occur much sooner then the emotional and mental affects on a couple. This process will only take longer and be more painful when unnecessary guilt is added. It is important to surround yourself with people who can support you through your process, and allow you the time and space you need to grieve. There is no “right” way to process your grief from a miscarriage. The way a person navigates their grief and the length of time it takes an individual to recover mentally and emotionally from miscarriage is as unique as the person going through it. Don’t compare yourself to others, and don’t put a time limit on yourself.